PRINTER'S NO. 3032
No. 2300 Session of 2000
INTRODUCED BY MUNDY, BROWNE, PISTELLA, BEBKO-JONES, MANDERINO,
NICKOL, L. I. COHEN, ROBINSON, HORSEY, DeWEESE, SCRIMENTI,
BELARDI, M. COHEN, DeLUCA, STABACK, BELFANTI, LAUGHLIN,
SANTONI, WOJNAROSKI, EVANS, MANN, ROEBUCK, TRICH, TRELLO,
SHANER, HUTCHINSON, COSTA, NAILOR, ORIE, SEYFERT, RUBLEY,
TRUE, WASHINGTON, YOUNGBLOOD, ZUG, HARHAI, WILLIAMS, McCALL,
TANGRETTI, DALEY, STEELMAN, YUDICHAK, VAN HORNE, ROONEY,
FRANKEL, THOMAS, MELIO, CIVERA, SAINATO, BLAUM, BATTISTO,
VEON, RAMOS, DALLY, McILHATTAN, ROSS, OLIVER, MASLAND, TIGUE,
BUXTON, COY, CURRY, EACHUS, GEORGE, GRUCELA, LaGROTTA,
LESCOVITZ, MICHLOVIC, PRESTON, STETLER AND SURRA,
FEBRUARY 16, 2000
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
FEBRUARY 16, 2000
AN ACT
1 Providing for the strengthening and enrichment of children and
2 families by promoting safe, healthy and nurturing home
3 environments, for the educational and supportive services of
4 home visiting programs in this Commonwealth, for the Ounce of
5 Prevention grant program and for integrated community-based
6 delivery of services; specifying program requirements;
7 establishing the Ounce of Prevention Board; providing for
8 responsibilities of the board and the Department of Health;
9 specifying criteria for community program grant funding;
10 requiring training and an independent evaluation process;
11 providing for quality assurance; and making an appropriation.
12 The General Assembly of the Commonwealth of Pennsylvania
13 hereby enacts as follows:
14 Section 1. Short title.
15 This act shall be known and may be cited as the Ounce of
16 Prevention Act.
17 Section 2. Legislative intent.
1 The General Assembly finds and declares as follows:
2 (a) Funding.--The General Assembly finds that family well-
3 being is critical to a child's health and development, that
4 parenting is a difficult responsibility and that most of the
5 assistance available to Pennsylvania families occurs after there
6 is a problem and often provides too little, too late. Research
7 shows that comprehensive early home visitation programs prevent
8 child abuse, help develop positive parent-child interactions,
9 help brain development of the child, have a long-term savings in
10 both public and private health care costs and help avoid future
11 social problems. In addition to addressing child abuse, such
12 programs help to ensure that families' social and medical needs
13 are met and that children are ready for success in school. The
14 General Assembly finds that Pennsylvania needs broad
15 implementation of a program to provide support for families
16 which need and desire assistance in establishing healthy
17 relationships and environments for their children.
18 (b) Intent.--It is the intent of the General Assembly to
19 establish the Ounce of Prevention Act as a collaborative effort
20 that builds on existing community-based home visiting and family
21 support resources and will not duplicate the existing services.
22 It is further the intent of the General Assembly to provide the
23 needed intensity and duration of services extending beyond those
24 available through Head Start and Early Head Start programs, thus
25 filling a major gap in the existing continuum of early childhood
26 prevention and assistance services.
27 Section 3. Ounce of Prevention Act.
28 (a) Establishment.--The Ounce of Prevention Act is hereby
29 established as a voluntary home visiting grant program for
30 expectant mothers and newborn children and their families.
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1 (b) Purpose.--The purpose of the act is to strengthen
2 families; promote early childhood growth and development;
3 improve childhood immunization rates and well-child care;
4 improve child health outcomes; improve school readiness;
5 increase family self-sufficiency; increase the involvement of
6 both parents with their children; and reduce the incidence of
7 child abuse and neglect through a primary prevention approach
8 that offers home visits and linkages to family supports for
9 families and their newborn children and continues until the
10 children reach five years of age or begin the Head Start
11 Program.
12 Section 4. Delivery of services.
13 Service delivery under this act shall be community-based and
14 collaborative. Services shall be integrated and coordinated with
15 other services provided under Head Start and Early Head Start
16 programs and by local school districts, as well as with other
17 home visiting and family support service delivery systems
18 currently in place in communities throughout this Commonwealth.
19 Services shall be offered with the intensity and duration
20 required to prevent child abuse and neglect, improve child
21 development and child health outcomes and to promote child
22 school-readiness and educational development.
23 Section 5. Program requirements.
24 The program created under this act shall provide for
25 intensive home visits and include the following critical home
26 visiting elements:
27 (1) Initiation of services. This element provides for:
28 (i) Initiation of services prenatally or at the
29 birth of the first child.
30 (ii) Use of a standardized assessment tool to
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1 systematically identify those at-risk families most in
2 need of services. The home visitor shall inform any
3 potential participant that the assessment or
4 participation in the program is purely voluntary.
5 (iii) Offering services on a purely voluntary basis
6 and use of positive, persistent outreach efforts to build
7 family trust.
8 (iv) Working with family members to identify
9 strengths and resources that can be mobilized to help
10 resolve identified family concerns.
11 (2) Service content. This element provides for:
12 (i) Offering services over the long term and
13 intensively, with well-defined criteria for increasing or
14 decreasing the intensity of the service.
15 (ii) Providing services that focus on supporting
16 first-time at-risk expectant parents and families,
17 encouraging the interaction of both parents with their
18 child, and enhancing the development of the child,
19 including school readiness and educational development.
20 (iii) Linking at-risk families to medical providers
21 to ensure optimal health and development of the child,
22 timely childhood immunizations, well-child care that
23 provides for developmental assessment and is consistent
24 with the standards and periodicity schedules of Medicaid
25 and the American Academy of Pediatrics and additional
26 services, as needed.
27 (iv) Ensuring confidentiality and privacy for
28 families.
29 (v) Having periodic evaluations of program
30 effectiveness.
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1 (vi) Having established mechanisms in place to refer
2 first-time at-risk expectant parents and families for
3 other intervention services available in the community.
4 (3) Qualifications and training of home visitors. This
5 element provides for:
6 (i) Ensuring that home visitors have basic training
7 in areas, including, but not limited to, substance abuse,
8 child abuse, domestic violence, drug-exposed infants and
9 parents, child development, services available in the
10 community, infant care and early childhood development,
11 school readiness and parenting.
12 (ii) Ensuring that home visitors conducting home
13 visits are certified registered nurses or are qualified
14 home visitors under 45 Code of Federal Regulations Part
15 1304.52(e) (relating to home visitor qualifications under
16 the Head Start and Early Head Start Programs).
17 (iii) Ensuring that home visitors have preservice
18 and ongoing training that is specific to their job
19 requirements.
20 (iv) Ensuring that home visit providers receive
21 ongoing reviews and direct and intensive supervision.
22 (v) Ensuring that home visitors are qualified
23 community-based private, not-for-profit or public
24 organizations that have strong community support and the
25 social and fiscal capacity to provide the service.
26 Section 6. Ounce of Prevention Board.
27 (a) Establishment and membership.--The Ounce of Prevention
28 Board is established within the Department of Health, with
29 membership as follows:
30 (1) The Secretary of Health or a designee.
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1 (2) The Secretary of Education or a designee.
2 (3) The Secretary of Public Welfare or a designee.
3 (4) Four members of the General Assembly, one appointed
4 by the President pro tempore of the Senate, one appointed by
5 the Minority Leader of the Senate, one appointed by the
6 Speaker of the House of Representatives and one appointed by
7 the Minority Leader of the House of Representatives.
8 (5) Seven nongovernmental members who have expertise in
9 at least one of the following areas: substance abuse, child
10 abuse, domestic violence, drug-exposed infants and parents,
11 child development, services available in communities, infant
12 care and early childhood development, school readiness,
13 parenting and prevention research with families and young
14 children.
15 (b) Nongovernmental members.--
16 (1) The Governor shall appoint the nongovernmental
17 members of the board in a manner that provides for regional
18 representation of this Commonwealth.
19 (2) Except as otherwise provided, the nongovernmental
20 board members shall serve a four-year term.
21 (3) Of the seven initial appointments, two shall be
22 appointed for a term of two years, two for a term of three
23 years and three for a term of four years.
24 (4) The Governor may reappoint nongovernmental board
25 members for successive terms.
26 (5) Nongovernmental members of the board shall remain in
27 office until a successor is appointed and qualified.
28 (6) If vacancies occur prior to completion of a term,
29 the Governor shall appoint another nongovernmental member in
30 accordance with this subsection to fill the unexpired terms.
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1 (c) Powers and duties.--The board shall have the following
2 powers and duties:
3 (1) To develop measurable outcomes consistent with
4 established home visiting programs operating in this
5 Commonwealth.
6 (2) To establish assessment and credentialing standards
7 for home visitation programs receiving grant funding under
8 this act.
9 (3) To review grant applications and award grants for
10 home visiting programs. No nongovernmental member may:
11 (i) Review grant applications or vote to award
12 grants to entities by which they are employed or with
13 which they are directly affiliated.
14 (ii) Be a lobbyist as defined under 65 Pa.C.S. Ch.
15 13 (relating to lobby regulations and disclosure).
16 (4) Grants for home visiting programs shall be awarded
17 on a three-year basis. The board may rescind a portion of the
18 grant not yet allocated if it determines through outcome,
19 expenditure and performance data submitted by the grantees
20 under section 7 that the funds are not being properly
21 utilized.
22 (5) Develop an assessment tool to identify at-risk
23 families who are eligible for home visiting grants under this
24 act. The assessment tool shall be a mechanism to identify
25 risk factors that may lead to child abuse or neglect or other
26 poor childhood outcomes.
27 (6) Establish policies for the development,
28 implementation and administration of this program.
29 (d) Board operation.--
30 (1) The Secretary of Health shall be the president of
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1 the board.
2 (2) The Secretary of Health, the Secretary of Public
3 Welfare and the Secretary of Education shall be nonvoting
4 members of the board.
5 (3) The board shall meet at least biannually to review
6 progress of home visiting programs in this Commonwealth,
7 establish priorities for grant funding, award grants and
8 advise the Department of Health on matters relating to
9 administration of the program.
10 (4) The Department of Health shall reimburse all
11 nongovernmental members of the board for all necessary and
12 reasonable travel and other expenses incurred in the
13 performance of their duties under this section.
14 Section 7. Implementation.
15 The Ounce of Prevention Board shall:
16 (1) Implement a community-based home visiting program
17 for first-time at-risk expectant parents and families in this
18 Commonwealth using the criteria set forth in this section.
19 (2) Develop a grant application and award grants under
20 this program in accordance with the following requirements:
21 (i) Grants must be awarded in accordance with
22 weighted criteria based on population demographics,
23 factors associated with child abuse and neglect and other
24 appropriate criteria developed by the board.
25 (ii) Cash or in-kind matching funds in the amount of
26 25% of the total program cost shall be required.
27 (iii) If a program is not able to meet the 25% match
28 requirement, justification must be included in the grant
29 application providing a detailed explanation of the
30 reasons why this match cannot be met and the percentage
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1 of the match that can be met. A determination will be
2 made by the board, without recourse, as to the merit of
3 the justification.
4 (3) Develop a plan of implementation to equitably
5 distribute funds throughout this Commonwealth.
6 (4) Require that, in addition to the program
7 requirements outlined in section 5, the following criteria be
8 used in selecting recipients of grant funds:
9 (i) Preference for grant awards must be given to
10 community-based entities that have broad representation
11 and have the fiscal and administrative capacity to
12 successfully implement the program.
13 (ii) Home visiting programs that receive grants
14 should collaborate with other home visiting and family
15 support programs in the community to avoid duplication
16 and complement and integrate with existing services.
17 (iii) Each applicant must use the standardized
18 assessment tool developed by the board under section 6.
19 (iv) Each applicant must provide outcome,
20 expenditure and performance data in the format and the
21 frequency specified by the board.
22 (v) Each applicant must identify local resources
23 available for implementation.
24 (vi) Implementation design must include service
25 delivery strategies that, when appropriate, involve both
26 parents if they have shared parental responsibility,
27 regardless of residential custody arrangements.
28 (5) Evaluate and approve grant applications and local
29 implementation plans for service delivery.
30 (6) Encourage applicants to coordinate service delivery
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1 with Head Start, Early Head Start, Parents as Teachers,
2 family centers, school districts and other existing home
3 visiting programs operating in communities in the various
4 regions of this Commonwealth.
5 (7) Identify qualified trainers and training
6 opportunities that will assure adequate opportunities for
7 grantees and their communities to provide preservice and in-
8 service training. Funds for training may be incorporated into
9 the grants.
10 (8) Develop and implement a quality assurance and
11 improvement process for the program.
12 (9) Identify and seek Federal matching funding for this
13 program.
14 (10) Identify existing State funding streams that could
15 be used to fund home visiting programs in this Commonwealth.
16 (11) Provide for an annual independent review that
17 evaluates both the progress and effectiveness of community
18 programs receiving grants and the overall progress and
19 achievement of the designated outcomes of the programs. The
20 Ounce of Prevention Board shall provide the review to the
21 Governor, the Senate and the House of Representatives on an
22 annual basis.
23 Section 8. Responsibilities of Department of Health.
24 The Department of Health shall allocate the staff and
25 financial resources necessary to assist the Ounce of Prevention
26 Board in the implementation and administration of this grant
27 program.
28 Section 9. Appropriation.
29 The sum of $10,000,000 is hereby appropriated to the
30 Department of Health for the fiscal year July 1, 2000, through
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1 June 30, 2001, to implement the Ounce of Prevention grant
2 program established under this act. An amount not to exceed two
3 percent of this appropriation may be used by the department to
4 cover the administrative costs of implementing and administering
5 the program.
6 Section 10. Effective date.
7 This act shall take effect immediately.
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